There was a recent thread where the topic of medical necessity came up, and I saw some common misconceptions in the comments (before the OP deleted the post).

A little about me - I’m ex-management from a 3-letter EMS agency we all know. I’m happily working as a flight medic now, but I still know quite a lot about this topic.

One of the common things I see EMT’s talk about is that “my company wants me to lie on my documentation”. I will absolutely agree that there’s a hard line between ensuring correct documentation and committing fraud for your employer.

IMHO, medical necessity for non-emergent BLS providers is the highest bar to prove. Us medics have it easy - “Pt. Required cardiac monitoring from Hospital A to Hospital B due to X” pretty much justifies ALS transport.

On the 911 side, medical need is much easier - it usually revolves around the patient perception of a medical emergency.

Now for the fine points:

It’s often fair to say that we assisted someone to the cot vs “patient walked”. If nothing else, I tend to have a hand on someone’s shoulder/arm in case they stumble. Often “patient was assisted in stand and pivot” is an accurate description, too. Many folks who may walk some of the time still aren’t able to tolerate non-medical transport (including wheelchair van) because of significant deconditioning or weakness.

Patients may also qualify for BLS transport because they are not be able to manage their own O2, or may be a fall risk, or be in a physical condition that they can’t tolerate sitting upright (severe contractures, hip precautions, casts). They may also require 1:1 monitoring for psychiatric reasons. These are all things that make wheelchair van travel unsafe for folks, so documenting them can be enough.

The Medicare standard is somewhat grey, and changes based on whomever is reviewing charts. Often if a patient truly doesn’t meet medical need, your employer may either send a different resource (wheelchair van) or will bill the sending facility directly. We often don’t know about these arrangements as front-line providers. In my past role, if you arrived and the patient truly didn’t need ambulance transport, you called dispatch to add a note, but you typically still did the transport.

One last thing - most insurances only cover ambulance transport for medical transportation, and if your documentation doesn’t justify the medical need that DOES exist, sometimes the patient is the one who gets billed.

TLDR?: “you’re not allowed to say the patient walked” isn’t the full story.

I got a job with a private ems company December 2nd working full time. And since then I’ve only ever been training and the 3rd person assisting a crew. Is that normal ?

Hey all. I’ve been working nights the last month 12a-12pm and it’s brutal. No matter how much I sleep I’m still exhausted throughout my shift. I’ve tried energy drinks and eating better foods but nothing helps. Can’t really do coffee cause it makes me have to go to the bathroom lol. Any tips on things that can help keep me up?? I get about 7 hours of sleep before my shift but it’s still tough.

Sorry for format, I’m on mobile.

I am thinking about a career in EMS. I want to start with an EMT cert and then eventually become a paramedic.

What is the best advice you can give to someone thinking about a career as a paramedic?

The job seems ideal for me. I never want to work in an office and I love to help people. Will I be disappointed trying to make this a career? I often see posts saying this job is not a “career”. Anyone who has made a career out of the job, is it worth it?

I’m a 3rd year nursing student and i feel like it’s silly but I hate being stuck in the hospital during clicnal I find working in the hospital kind of boring like I know ems isn’t 24/7 out of the hospital but on my rotation in emergency medicine I felt jealous of the paramedics it felt more my speed and after having a chat with one of them it feels like I’d enjoy that more even with the pay cut. Just wondering what options are there for nursing out of the hospital and if anyone has advice. I found a local paramedic program and they’ll credit me for some classes from nursing so I’m thinking about switching. It feels silly but I think if I never even tried I’d regret it.

I’m in a known college that has a 50/50 passing rate for Paramedic. Reading Nancy Caroline’s emergency care in the streets. I feel like I’m highlighting too much as it’s taking me 8 hours a day. Had the same problem in EMT.

So, I am early fourty's, generally fit, decided on a career change. Going from an office job to EMT. So after a particularly Intense 2 day CPR training, I noticed my knees were incredibly painfull. Now I'm wondering, are my knees abnormally pointy or is this normal? If it is, how do you deal with it?

I understand 2 days of CPR training is not representative for average EMT day to day. But I do think EMT's kneel regularly. I didn't want my age/ fitness to be a factor in patient outcome, so before applying I spent quite a lot of time on exercise to ensure I was up to it. Maybe this is a silly and small thing to fixate on, but it just came as a surprise.

A couple days ago I got hired at an ambulance company in Orange County, CA. I had basically every certification or license that was required of me when they hired me, except for the ambulance driver/attendant course.

I got my EMT CA state card in the mail the day before I got hired, so prior to getting hired, I was unable to complete the ambulance driver/attendant application... Now that I am hired and starting the job in 2 weeks, I was told to get the ambulance driver license before then.

However, when I go on the OCEMS licensing site to apply, it is asking me to upload "proof of completion of an approved OCEMS EMT Accreditation or Ambulance Driver/Attendant course pursuant to OCEMS Policy #415.00." I looked on #415.00 and there were no courses listed there... I googled "OCEMS approved ambulance driver course" and found one, but the next class is too far out. It would be great if someone could point me in the right direction to find a class I can take.

I know that a lot of OC EMT classes come with that course cert already, but I did my course in the military overseas, so that will not apply to me...

Cant wait to start this new career!!

TLDR: Where do I find OC-approved ambulance driver courses??

Looking for advice on where to go to medic school. I live near the Mecklenburg county area of the state. Would really like to do an associate degree program as I’m trying to eventually bridge to nursing in the future.

Already an EMT

Graduated my EMT program a month ago, not working in the field just yet. Kinda terrified of being in public when someone starts to choke, pass out etc.... I still feel like I know nothing, yet my friends and family would surely expect me to jump in and help. And don't get me wrong I would WANT to help. It's just daunting. Any advice on how to get over this?

As anyone heard about it or worked at liferide in New Jersey. They have two bases one in Paterson nj and one in Livingston?

Edit: Thank you to everyone who offered advice! I've got some good things to think about as I plan my next steps.

I just need a sanity check here.

I (30M) graduated with an IT bachelor's last year, and have had no luck getting my first entry level job. The market shows no signs of improving, and other indicators (political, economic, etc.) suggest that it is only going to get worse. My current job is seasonal and was really only good for while I was in school.

My backup plan is to get my EMT-B, work for a while, and then try to get into a police academy (CA). Am I an idiot or does this seem like an alright plan?

So I live in Alabama and I am wanting to work in Tennessee, I know I need to file for reciprocity in the state of Tennessee but I’m not sure about my license and all my course work. Like do I need to take my EVOC again in Tennessee or do I need to get a Tennessee drivers license how does this work?

Help me out here. I’m a 20yo who’s about to start his experience as a volunteer with the Italian Red Cross (who also specializes in EMS activities), and I was wondering if it’s appropriate to carry a pocket knife while on duty.

The knife in question is one of those EMT pocket knifes (the ones with the seatbelt cutter and the glass breaker on the handle). It’s not a small knife. Closed is around 14cm long, and the blade is around 12cm (5 inches, for our American friends).

I wanna make it clear that I absolutely don’t mean to keep it for self defense purposes (that’s for the police to handle), it’s more a matter of “it’s better to have it on you than not to”.

And of course I wouldn’t open carry it, coz that would just be incredibly stupid. I’d just keep it in a pocket closed with a zip, where it could still be easily reached in case of need.

Now, the question is, is it worth to carry it? Would I be risking some kind of problem with my colleagues or my superiors? Would I be exposing myself to disciplinary actions or something like that?

Sorry for the incredibly long post, and thank you in advance to those who will take the time to answer!

I’m trying to become an EMT and I enrolled in a course called JB Learning and the course has been over the last 4 and a half weeks. It’s super fast paced and I feel like a lot of things have slipped through the cracks in my knowledge and I am struggling. The course has me taking the nremt in 5 days and I’m super worried I’m not going to pass. I’ve taken the mock test on Medic Tests and got like a 850, I’ve taken the Pocket prep mock test and got a 73%. And the more I take these test just makes me feel like I’m not going to pass. I really want to do become an emt and am extremely nervous about failing this test. Is there any chance of me passing the nremt? What should I do? Please help. Thanks

Hi, I'm a fairly new EMT working BLS 911 in a busy area. When I take a patient from ALS to the hospital as a BLS transport, what are some good medication names to know for the hospital? Specifically I think blood thinners. Most patients with falls and bleeds become BLS, but I do not know what medications are thinners. I have had the problem of nursing staff asking if they are on thinners and have had trouble answering. Is there a list of good medications to know as an EMT for issues like blood thinners? Or is there a way to look at a PT's history more effectively?

I have dreamt of being in the EMS field since I was a little kid. I am now 21. I took my EMT course in October, passed my exam in November, started working in December, and now February I am officially cleared. I have loved almost every second of the job, and the few seconds I did not like was when I was working with miserable and grumpy people. People keep telling me I'm only happy right now because I'm in the honeymoon phase, and that I'll get sick of it after a few months. I know most calls are bs and they get exhausting. But they aren't bs to the patients. And that's all I care about. To the patient, they are having a serious emergency and need help. And I want to be there to comfort them and help them the best that I can.

I'm terrified of hating this job and becoming another grumpy miserable EMT. Is the job really that bad after a few months? Am I going to regret getting into this? How can I keep myself from getting burnt out like the other people I've talked with?

Also any advice for a newly cleared EMT is welcome!!!

I just got my paramedic and started working full time 48/96. It feels like an obstacle course trying to explain to people that I am literally at the station for 48 hours but no I am not awake that whole time (hopefully), what posting is, the difference between paramedic and basic, how many people are at the station/on the truck/at a call, etc etc. The ins and outs don’t matter for some stranger, but to friends and family who are trying to understand better what you do while at work, what do you tell them?

2:42 AM, not on shift, just woke up from some dream I’ve already forgotten, and I just realized that I don’t think I’ve had any actual training, seen any formal protocol, or even really had a real discussion about PCRs on DOAs. I don’t recall anything in the textbooks, either.

Do yall have any protocols on these? Or otherwise general advice? I try to do a great job painting a 1000% unbiased picture, just stating what I see without making any assumptions about cause of death, on all DOA patients, but, really, I don’t really do much different on regular reports. I also try my best to get a SAMPLE, either from bystanders/family or from exploring the house a little bit for pill bottles or other findings, signs of a messy GI bleed in the bathroom, as well as prescriptions in the medicine cabinet, for example. Really, my concern is the final part, is it cool to search the house a little, if they died in an otherwise uninhabited place?

Moving to Colorado soon, just trying to take into account everything before I decide where to move, I keep seeing comments that Falck in Aurora runs 911s but that they’re not a good company to work for. Please anyone who knows why can you explain why? I really don’t want to work for a company that has bad management but obviously we all have a different idea of what that means, so any detailed insight would be awesome. I haven’t worked for a private company before so I don’t get what people mean when they say private companies have issues?

Thanks!

Im in California and Im trying to get my DOT physical / medical examiners so I can get my CA Ambulance License .. anyone ever got their DOT done at a MinuteClinic at CVS? What places do you recommend hitting up for this? Are they all like $200 usually lol

How do y'all maintain friendships while working odd hours and days in EMS? I find so often that I get the "I don't know when you work!" or "I was gonna ask but wasn't sure if you were at work!" excuse, and I've heard it from a lot of my coworkers as well. How do you guys maintain friendships with people who aren't first responders or healthcare workers? Starting to wonder if it's even possible at all lol.

I’m hoping someone here may be able to help me. I’m currently in the process for re-certifying my lapsed EMT-B. It’s been a bit so I’m doing the re-entry pathway. (40hrs of CE’s, Skills test, and Practical/written test).

I’ve already done everything and taken my test again, and all that remains is the skills test. Which appears not to be offered in Oregon. I reached out to OHA, who directed me toward my local EMT schools, but unfortunately they don’t offer it and just referred me back to OHA.

So I’m at a bit of a loss. Does anyone know where I can get my skills signed off?

Anyone has any recommendations where to apply? I live in Stockton, CA. I recently got my ADL, so I have everything now.

But I can't find job postings within an hour distance that don't require experience already. I thought it was supposed to be easy to get a job upon completion? I'm open to IFTs and 911 jobs. Any help is appreciated.

Thanks.

Currently at a 75.38 at the West Coast EMT Torrance location, took the accelerated course and quite frankly I think i understand the material well enough, but the first two weeks I wasn’t applying myself at all. I would space out in class cause my gf had broken up with me about a week and a half prior to the class start. Now that I’m getting over it a little, I’m doing much better. Any tips from anyone who’s taken any West Coast Course? They’re allowing me to retake my lowest exam scores, which are block 1 & 2. Of course I wanna pass my first try, but if I can’t pull this off then I’ll be back for their March course. Not too worried about skills other than the Trauma assessment but I just need to make it to the final exam. I think a 94 on that exam would get me an 80% so again, any flash cards anyone has that would help with that block would be greatly appreciated.

Hello fellow providers,

So, I recently did my first series of shifts, and well it was a ride. I learned a lot and i had my first mess-up, where I was basically in shock at my first serious case and well, didn't perform up to my expectations. Luckily it wasn't anything major, but it left an extremely bitter taste in my mouth, and my attachment ended before I could get a chance to experience another serious case and improve.

I have a few questions:

1. I received a few comments that I was too hasty( I don't know the exact word in English), how do I improve on this?

2. How do I ensure I don't mess up again? I'm very worried that one day, as a proper provider I may mess up again but then someone's life is on the line.

To any newbies reading this, go for your first ride-along, it has taught me a large amount of valuable lessons, both about the medical aspect of EMS and also the social aspect. I just want to get some opinions of the more experienced crowd here on how to work through some of the issues I faced in order to become a better medic. Thanks in advance.

I currently work in an allied Healthcare setting in higher education. I've been think of switching over to EMS and the fire side of this more so. I already have my EMT basic as a secondary certificate with my current job but Im thinking of using that as my primary. I've been looking at how to get involved with Fire and how to change into becoming a firefighter/EMT. Would it be worth looking into attending a community college career pathway Fire academy or just try to find a job board with entry-level firefighting positions and apply there?? Hat are the benefits of doing the community college fire academy track vs. Just department fire academy? I'm just worried, i dont have specific EMT job experience as it's secondary to my current role and trying to stand out in the application process might be difficult if I don't have any EMS specific things besides ski patrol volunteer. Wh

Hi all! I’m looking for recommendations for infant and child CPR training or resources taught in Hindi, ideally in person in Northern NJ or NYC (but virtual is also ok). I don't need actual certification, just a class teaching signs and what to do in the event of choking.

I have reached out to our local hospital as well as to our baby's pediatrician and haven't been able to find anything. I'd really appreciate any recommendations, or if you are certified to teach and would be willing to do a private lesson or a small group session in this area PLEASE DM me!!

Just completed my AMR Interview ! Just wondering if they reach back to you about an offer soon or do they take a while . Asked a bunch of questions except that one lol